Journal Article > Study

Patient safety initiatives will increasingly balance the tension between systems change and individual accountability, and medical professionalism is often at the center of this discussion. Although certain behaviors in medical school predict unprofessional behavior, efforts to teach these skills have been described, particularly in addressing disruptive behavior. This study surveyed physicians and found that nearly 70% believe that it is their professional responsibility to report an impaired or incompetent colleague. However, of those with knowledge of such a colleague, 33% failed to report them to a relevant authority. Barriers to reporting included a belief that it wasn't their responsibility, nothing would happen from reporting them, and fear of retribution. A related editorial discusses medical professionalism in the context of this study's findings and weighs different strategies to address the challenges. A past AHRQ WebM&M conversation and commentary also discuss professionalism and patient safety.

Journal Article > Study

The safety impact of the ACGME trainee work hour restrictions remains controversial due to contrasting findings that have suggested benefit, harm, and no significant impact. This observational study analyzed all Medicare patients admitted to acute care facilities with a predefined set of primary diagnoses to estimate the 30-day mortality among high-severity medical admissions and the failure to rescue in postoperative surgical admissions. Investigators found no significant harm or benefit to patients with higher-severity illness compared with those with lower risk among both the medical and surgical patients. A past AHRQ WebM&M perspective discussed the impact of fatigue and extended shifts among trainees on the incidence of medical errors.

Journal Article > Study

The importance of standardized handoff communications in preventing errors is underscored by its inclusion as a National Patient Safety Goal, and specific guidelines have been developed to promote safe handoff practices. Despite this, multiple studies demonstrate that signout practices are still suboptimal, particularly at academic hospitals. Further corroborating evidence is supplied by this survey of medical and surgical residents at a teaching hospital. The majority of residents reported witnessing patient harm due to inadequate signouts, and signout practices often did not conform to recommended guidelines—specifically, signouts were often conducted over the phone or were subject to frequent interruptions. An AHRQ WebM&M commentary discusses a case of an inadequate signout that resulted in an adverse event.